From the Guidelines
Meniscal injuries should be initially managed with conservative treatment, including the RICE protocol and physical therapy, rather than immediate surgical intervention, as evidenced by the most recent and highest quality study 1.
Symptoms of Meniscal Injury
Meniscal injuries typically present with knee pain, swelling, catching or locking sensations, and limited range of motion. The symptoms can vary depending on the severity and location of the tear.
Management of Meniscal Injury
Management begins with the RICE protocol: Rest the knee, apply Ice to reduce swelling, use Compression bandages, and Elevate the leg. Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) can help manage pain and inflammation for 1-2 weeks.
- Physical therapy focusing on quadriceps and hamstring strengthening is essential for recovery, with exercises like straight leg raises, hamstring curls, and stationary cycling.
- A 12-week supervised exercise programme has been shown to be as effective as arthroscopic partial meniscectomy in improving functional outcomes and reducing pain in patients with degenerative meniscal tears 1.
Surgical Intervention
For severe tears or persistent symptoms, surgical intervention may be necessary, typically arthroscopic partial meniscectomy or meniscal repair. However, surgical treatment should not be considered the first line intervention for patients with knee pain and meniscal tear 1. Recovery from surgery requires 4-6 weeks for partial meniscectomy or 3-6 months for repair, with progressive rehabilitation.
Importance of Early Diagnosis and Management
Meniscal injuries occur when twisting forces are applied to the knee while weight-bearing, damaging the C-shaped cartilage pads that cushion the knee joint. Proper treatment is crucial as the meniscus has limited blood supply, particularly in its inner portions, which affects healing potential. Early diagnosis and appropriate management help prevent long-term knee instability and premature osteoarthritis. The American Academy of Orthopaedic Surgeons (AAOS) recommends a non-surgical approach as the initial treatment for osteoarthritis of the knee, which is often associated with meniscal tears 2.
From the Research
Symptoms of Meniscal Injury
- Meniscal injuries can cause knee pain and disability, with the medial meniscus being more vulnerable to injury due to its attachment to the medial collateral ligament 3
- The moveable lateral meniscus is less prone to tear, except when the ACL is injured 3
- Older patients may present without a specific mechanism of injury, as their meniscal injuries are often due to degenerative processes 3
- Joint line tenderness and the presence of a knee effusion can aid in the diagnosis of meniscal injury 3
Diagnosis of Meniscal Injury
- A thorough physical examination utilizing the McMurray, Apley, and "bounce home" maneuvers can diagnose most meniscal injuries 3
- Magnetic Resonance Imaging (MRI) is the test of choice for confirming injury and defining the type, location, and severity of meniscal injury 3
Management of Meniscal Injury
- Typical initial management includes reduction of swelling and pain, followed by rehabilitation that stresses tri-planar functional retraining 3
- Arthroscopic knee surgery is a prevalent treatment method for bucket handle tears and non-vascularized meniscal injuries 3
- Meniscal repair is currently preferred over partial menisectomy to avoid premature osteoarthritis 3, 4
- Biologic augmentation and material-based systems are being developed to enhance meniscal repair and promote meniscal healing 4
- Rehabilitation and return to play guidelines are important for preserving the meniscus and preventing degenerative changes 5